Revenue Cycle Metrics
The key performance indicators (KPIs) that measure the health of the revenue cycle — what each metric means, how it is calculated, and how to read it, with authoritative sources.
- Appeal overturn rate
The appeal overturn rate is the share of appealed denials a payer reverses — a measure of how sound the appeals are, and of how many denials were wrong.
- Bad debt rate
The bad debt rate is money that was owed and not collected, measured against gross patient service revenue — the share of billed revenue written off because someone able to pay did not.
- Charge lag
Charge lag is the average number of days between the date of service and the date the claim is submitted — the part of the timely-filing window you spend yourself.
- Claim rejection rate
The claim rejection rate is the share of claims returned by an edit before adjudication — a measure of submission quality that never appears on a remittance.
- Clean claim rate
The clean claim rate is the share of claims accepted on first submission without edits or rejections — a leading measure of front-end and coding accuracy.
- Cost to collect
Cost to collect is total revenue-cycle cost measured against the cash actually collected — what it costs a practice to turn a service into money in the bank.
- Days in A/R
Days in accounts receivable is the average time to collect after care is delivered — a core measure of how quickly a practice turns services into cash.
- Denial rate
The denial rate is the share of claims a payer refuses to pay on adjudication — a core measure of revenue-cycle friction, best read by trend and by reason.
- Gross collection rate
The gross collection rate is payments against billed charges — a figure that says more about how a practice sets its charges than about how well it collects.
- Net collection rate
The net collection rate is the share of collectible revenue — after contractual adjustments — that a practice actually collects, measuring how completely earned revenue is captured.
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